CLOUD COUNTY HEALTH CENTER INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- CLOUD COUNTY HEALTH CENTER INC (EIN 48-0545923)
- Tax period
- 2022-10-01 to 2023-09-30
- Filed
- 2024-08-14
- IRS object ID
- 202442279349303264
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-08-14T16:11:54-05:00 | ReturnTs |
| Tax Period End | 2023-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480545923 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cloud County Health Center Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLOU | BusinessNameControlTxt |
| Phone | 7852431234 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 W College Dr | AddressLine1Txt |
| City | Concordia | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ron Harrington | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7852431234 | PhoneNum |
| Signature | 2024-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2024-08-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2024-08-08 14:25:15Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | North Central Kansas Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | David Garnas | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 W College Dr | AddressLine1Txt |
| City | Concordia | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,552,398 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.nckmed.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1970 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | Operation of critical access hospital | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,223,487 | PYContributionsGrantsAmt |
| CY Contributions Grants | $635,984 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,821,707 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,896,339 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,683 | PYInvestmentIncomeAmt |
| CY Investment Income | -$1,936 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,893 | PYOtherRevenueAmt |
| CY Other Revenue | -$517 | CYOtherRevenueAmt |
| PY Total Revenue | $20,058,770 | PYTotalRevenueAmt |
| CY Total Revenue | $23,529,870 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,050 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,815,503 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,694,404 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,501,625 | PYOtherExpensesAmt |
| CY Other Expenses | $10,923,331 | CYOtherExpensesAmt |
| PY Total Expenses | $18,319,628 | PYTotalExpensesAmt |
| CY Total Expenses | $24,619,785 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,739,142 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,089,915 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $46,728,571 | TotalAssetsBOYAmt |
| Total Assets EOY | $49,143,712 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $34,564,275 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $38,746,190 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,164,296 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,397,522 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Cloud County Health Center is committed to providing quality health care services delivered in a caring and respectful manner through teamwork and professional excellence. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,941,108 | ExpenseAmt |
| Grant | $2,050 | GrantAmt |
| Revenue | $22,896,339 | RevenueAmt |
| Desc | Cloud County Health Center (Health Center) is a nonprofit acute care hospital located in Concordia, Kansas. The Health Center provides inpatient, outpatient, Rural Health Clinic and Emergency care services to residents of Cloud County and the surrounding area. Health Center had a total of 234 discharges and 1,524 patient days. The hospital had a total of 352 surgeries, 2,950 ED visits and 25,300 OP visits and the Family Care Center had 16,442 visits. In addition to providing Inpatient and Outpatient services, the hospital provides the following ancillary services: Lab, Imaging, Pharmacy, Respiratory Therapy, Rehab services, and Sleep Lab services. Imaging services include all of the following areas: General X-ray, CT Scan, Nuclear Medicine, Ultrasound, Bone Density and Mammography services. A new MRI unit was installed in November 2022 when we moved to our new hospital facility. | Desc |
| Total Program Service Expenses | $18,941,108 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Ron Harrington | PersonNm |
| Phone | 7852431234 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 W College Drive | AddressLine1Txt |
| City | Concordia | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Philip Gilliland | ||||||||
| Chairperson | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Kurt Kocher | ||||||||
| Vice Chairperson | 1.00 | 0.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Charles Lambertz | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Amy Lange | ||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Joanne Balthazor | ||||||||
| Director | 1.00 | 0.10 | Yes (X) | $0 | $0 | $0 | ||
| Quentin Breese | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Darrell Gallegos | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Darrel Hosie | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Amber Knoettgen | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kent Otott | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sister Jean Rosemarynoski | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Justin Poore | ||||||||
| Chief of Staff/Physician | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| David Garnas | ||||||||
| Adminstrator/CEO | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Ronald Harrington | ||||||||
| CFO | 40.00 | 0.10 | Yes (X) | $0 | $0 | $0 | ||
| Dorothy Breault | ||||||||
| Physician | 40.00 | 0.00 | $268,487 | $0 | $39,462 | Yes (X) | ||
| Brandon Fraley | ||||||||
| Advanced Practice Provider | 40.00 | 0.00 | $158,148 | $0 | $10,294 | Yes (X) | ||
| Daniel Garlow | ||||||||
| Physician | 40.00 | 0.00 | $284,012 | $0 | $31,949 | Yes (X) | ||
| Shawna Huggans | ||||||||
| Advanced Practice Provider | 40.00 | 0.00 | $185,007 | $0 | $32,666 | Yes (X) | ||
| Tiffany Naccarato | ||||||||
| Advanced Practice Provider | 40.00 | 0.00 | $179,692 | $0 | $8,985 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,075,346 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $123,356 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Salina Regional Health Center | |||||
| 400 South Santa Fe | Salina | KS | 67401 | Payroll and Other Reimbursement | $21,843,000 |
| Qualivis LLC | |||||
| PO Box 123847 | Dallas | TX | 753129847 | Contract Labor | $386,663 |
| Lindsborg Laundry | |||||
| 304 E Lincoln St | Lindsborg | KS | 67456 | Laundry Services | $278,637 |
| Treanorhl | |||||
| 1040 Vermont Street | Lawrence | KS | 66044 | Architechture Services | $253,033 |
| Integrated Solutions | |||||
| PO Box 871854 | Kansas City | MO | 64187 | Computer Services | $192,992 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $367,229 | RelatedOrganizationsAmt |
| All Other Contributions | $268,755 | AllOtherContributionsAmt |
| Total Contributions | $635,984 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621400 | $21,246,438 | $21,246,438 |
| Pharmacy Revenue | 900099 | $1,006,359 | $1,006,359 |
| Cafeteria revenue | 900099 | $81,948 | $81,948 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $561,594 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $561,594 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,896,339 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,592 | TotalRevenueColumnAmt |
| Exclusion | $20,592 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $22,528 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$22,528 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$22,528 | TotalRevenueColumnAmt |
| Exclusion | -$22,528 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Miscellaneous revenue | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | -$517 | TotalRevenueColumnAmt |
| Exclusion | -$517 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$517 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,529,870 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,896,339 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$2,453 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,050 | TotalAmt |
| Program Services | $2,050 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $846,392 | TotalAmt |
| Program Services | $382,494 | ProgramServicesAmt |
| Management And General | $463,898 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,602,196 | TotalAmt |
| Program Services | $8,708,045 | ProgramServicesAmt |
| Management And General | $1,894,151 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $327,506 | TotalAmt |
| Program Services | $294,411 | ProgramServicesAmt |
| Management And General | $33,095 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,134,850 | TotalAmt |
| Program Services | $872,649 | ProgramServicesAmt |
| Management And General | $262,201 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $783,460 | TotalAmt |
| Program Services | $624,558 | ProgramServicesAmt |
| Management And General | $158,902 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,917 | TotalAmt |
| Management And General | $3,917 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,386 | TotalAmt |
| Management And General | $11,386 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,037 | TotalAmt |
| Program Services | $3,037 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,095,937 | TotalAmt |
| Program Services | $1,053,946 | ProgramServicesAmt |
| Management And General | $1,041,991 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,833 | TotalAmt |
| Management And General | $57,833 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $421,287 | TotalAmt |
| Program Services | $278,942 | ProgramServicesAmt |
| Management And General | $142,345 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $289,678 | TotalAmt |
| Program Services | $83,113 | ProgramServicesAmt |
| Management And General | $206,565 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $359,893 | TotalAmt |
| Program Services | $283,685 | ProgramServicesAmt |
| Management And General | $76,208 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,043 | TotalAmt |
| Program Services | $45,730 | ProgramServicesAmt |
| Management And General | $29,313 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,558 | TotalAmt |
| Program Services | $1,480 | ProgramServicesAmt |
| Management And General | $78 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $977,453 | TotalAmt |
| Program Services | $770,478 | ProgramServicesAmt |
| Management And General | $206,975 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,406,437 | TotalAmt |
| Program Services | $2,685,125 | ProgramServicesAmt |
| Management And General | $721,312 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,391 | TotalAmt |
| Program Services | $15,061 | ProgramServicesAmt |
| Management And General | $67,330 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical and Patient Sup | $2,837,288 | $2,782,902 | $54,386 |
| Food Costs | $130,627 | $3,610 | $127,017 |
| Dues, Licenses, and Tax | $82,014 | $34,292 | $47,722 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,552 | TotalAmt |
| Program Services | $15,500 | ProgramServicesAmt |
| Management And General | $72,052 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,619,785 | TotalAmt |
| Program Services | $18,941,108 | ProgramServicesAmt |
| Management And General | $5,678,677 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $617,164 | BOYAmt |
| EOY | $58,523 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,272,138 | BOYAmt |
| EOY | $2,195,244 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $289,348 | BOYAmt |
| EOY | $167,986 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $227,600 | BOYAmt |
| EOY | $393,113 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $51,206,746 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,406,741 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,478,421 | BOYAmt |
| EOY | $41,800,005 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,146,075 | BOYAmt |
| EOY | $833,378 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,697,825 | BOYAmt |
| EOY | $3,695,463 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,728,571 | BOYAmt |
| EOY | $49,143,712 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,654,387 | BOYAmt |
| EOY | $923,213 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,551,431 | BOYAmt |
| EOY | $37,822,977 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $358,457 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,564,275 | BOYAmt |
| EOY | $38,746,190 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,018,451 | BOYAmt |
| EOY | $9,564,374 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,145,845 | BOYAmt |
| EOY | $833,148 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,164,296 | BOYAmt |
| EOY | $10,397,522 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,728,571 | BOYAmt |
| EOY | $49,143,712 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,089,915 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$676,859 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,037 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,037 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | A portion of annual dues paid by Cloud County Health Center to the Kansas Hospital Association (KHA) has been identified as association lobbying activities by KHA. Cloud County Health Center does not directly participate in lobbying activities. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $719,202 | OtherCostOrOtherBasisAmt |
| Book Value | $719,202 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $35,358,864 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,938,768 | DepreciationAmt |
| Book Value | $33,420,096 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,613,318 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,416,871 | DepreciationAmt |
| Book Value | $7,196,447 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $515,362 | OtherCostOrOtherBasisAmt |
| Depreciation | $51,102 | DepreciationAmt |
| Book Value | $464,260 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $41,800,005 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from Salina Regional Health Center | $1,995,486 |
| Estimated Third-Party Payor Settlements | $1,699,977 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,695,463 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $26,456,051 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $3,292,393 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$366,729 | OtherRevenueAmt |
| Revenue Not Reported | $2,925,664 | RevenueNotReportedAmt |
| Revenue Subtotal | $23,530,387 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$517 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$517 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $23,529,870 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $27,910,128 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $3,292,393 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $3,292,393 | ExpensesNotReportedAmt |
| Expenses Subtotal | $24,617,735 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $2,050 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $2,050 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $24,619,785 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Medical Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Change in beneficial interest of Foundation -366,729. |
| Part XI, Line 4b - Other Adjustments: | Net Auxiliary Income -517. |
| Part XII, Line 4b - Other Adjustments: | Auxiliary expense 2,050. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $280,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $280,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01140 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,280,631 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $813,905 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,466,726 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05960 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,560,631 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $813,905 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,746,726 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,675,254 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,139,625 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,535,629 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14360 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,675,254 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,139,625 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,535,629 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14360 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,235,885 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,953,530 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,282,355 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21460 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,145,353 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,526,453 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,604,956 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$78,503 | MedicareSurplusOrShortfallAmt |
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cloud County Health Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 W College Drive | AddressLine1Txt |
| City | Concordia | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.nckmed.com | WebsiteAddressTxt |
| State License | H015001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cloud County Health Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Section C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Section C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | nckmed.com/patient-and-visitors/financial-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | nckmed.com/patient-and-visitors/financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | nckmed.com/patient-and-visitors/financial-assistance | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Cloud County Health Center | Part V, Section B, Line 5: On April 28, 2022, the Community Health Needs Assessment Committee met and discussed ways to involve the community in addressing the most important health needs of Cloud County. The group decided to survey the community, asking for their input on priority of the following areas:- Obesity- Depression/Mental Health- Diabetes- Heart Disease- Tobacco Use Including vaping and chewing- Stroke- Trauma/Falls- Hypertension (high blood pressure)- High cholesterol- Substance Abuse- Transportation to Medical ServicesThe survey was launched through all forms of media for a period of six weeks. 118 surveys were received and tabulated. The Community Health Needs Assessment Committee met in July to review the results and discuss an implementation plan. The Committee consists of 25 members from various organizations in the community. |
| Cloud County Health Center | Part V, Section B, Line 11: The following community health priority areas were identified in the most recent CHNA. 1) Obesity 2) Depression/Mental Health 3) Diabetes 4) Heart Disease 5) Tobacco Use 6) Stroke 7) Trauma/Falls 8) Hypertension 9) High Cholesterol 10) Substance Abuse 11) Transportation to Medical ServicesAlthough all of the above are important and will be addressed as part of our regular operations, the hospital will focus on Obesity (including trauma/falls), Depression/Mental Health, and Substance Abuse, including Tobacco Use during fiscal years ending in 2023-2025. With assistance from other organizations, we will address the issues through the following steps:#1 - Provide Opportunities to Stabilize Mental Health We continue to educate the Community on these issues with education materials and through conversations with Hospitals in Topeka when we have patients that need to be transferred out of the Emergency Department. The Health Center continually works to develop more telehealth access for Pawnee, Health Department, and the Schools in the District.#2 - Provide ways to decrease Obesity in the Community and include Education of Health issues leading to Obesity The hospital started a Stepping On class for our senior population. They have a class twice a year, once in the Spring and the other in the Fall time frame. An instructor works with the senior community on ways to strengthen their motor skills and prevent falls at home. Two programs have begun, TOPS program in January of 2023 and the Stay Strong Program, an extension of Kansas State, to have pre- and post-surveys used to determine what degree of behavior has changed. #3 - Develop ways to decrease Substance abuse and Tobacco use We continue to provide education materials to patients, and we participate in the Great Smoke Out Day each year. We also provide education on smoking cessation classes and offer patients nicotine smoking patches within the Clinic and/or Emergency department. |
| Cloud County Health Center | Part V, Section B, Line 13h: Presumptive eligibility may be used if the other options are not available. |
| Cloud County Health Center | Part V, Section B, Line 24: The hospital financial assistance policy does not cover elective procedures. The hospital may have charged FAP eligible patients gross charges for services that are not covered under the financial assistance policy. |
| Part V, Section B, Line 7a | nckmed.com/about/community-health-needs |
| Part V, Section B, Line 10a | nckmed.com/about/community-health-needs |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - Family Care Center Clinic | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 W College Drive | AddressLine1Txt |
| City | Concordia | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Rural health clinic | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | The methodology used to determine eligibility for financial assistance takes into consideration income, net assets, family size, medical indigency, insurance and underinsurance status. Presumptive eligibility may be used if the other options are not available. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7A based on an overall cost-to-charge ratio addressing all patient segments. Line 7B, Medicaid, was determined based on the costing methods used to prepare the cost reports. Line 7G was obtained from the Medicare Cost Report. |
| Part I, Line 7g: | Rural health clinic revenue of $1,877,759 and expense of $4,392,254 are included on line 7g. The net cost of rural health clinic subsidized services is $2,514,495. |
| Part III, Line 2: | The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. |
| Part III, Line 4: | The footnote to the organization's financial statements that describes implicit price concession is located in the audited financial statement report on page 13. |
| Part III, Line 8: | The Medicare payments are compared to the actual cost of providing the service as arrived at through the Medicare cost reports. Medical services are provided to patients with Medicare coverage regardless of whether or not a surplus or deficit is realized. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. |
| Part III, Line 9b: | Collection practices do not apply to patients who have an approved payment plan in effect provided payments are kept current. Patients who have qualified for 100% financial assistance would not go to collection as their account balance would be reduced to zero prior to getting to the collection stage. Patients who qualify for less than 100% assistance may go to collection if their balance is not paid according to an agreed upon schedule. Accounts that are deemed to qualify for financial assistance while in collections will be removed from collections and returned to the business office. |
| Part VI, Line 2: | The hospital has an 18 member CHNA committee that meets quarterly at the hospital to discuss the healthcare needs in the community. Members include staff from the hospital, health department representatives, city and county government officials, school leaders and city business leaders. |
| Part VI, Line 3: | The hospital does the following to educate patients on the financial assistance offered at CCHC; (1) posts its financial assistance policy and financial assistance contact information on its website, in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present; (2) provides a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) includes the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (4) discusses with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. |
| Part VI, Line 4: | CCHC is located in Concordia, KS. Concordia is the county seat of Cloud County. It is a Rural community with an estimated population of 5,111 per the 2020 census data. The population has decreased since 1980 when the estimated population was 6,847. Current estimated population as of 2022 was 5,054.Concordia is home to Cloud County Community College located just off highway 81 in Concordia.Concordia is surrounded by healthcare facilities in all directions. To the North in Belleville, KS is Republic County Hospital located 18 miles north of Concordia, KS. To the East is Clay County which has Clay County Medical Center that is approx. 45 miles from Concordia. To the South is Ottawa County approx. 33 miles which has a facility in Minneapolis, KS. Then, to the West is Mitchell County approx. 32 miles and has a facility in Beloit, KS. |
| Part VI, Line 5: | The Hospital has a Rural Health Clinic within the hospital and provides services Mon thru Fri from 8:30am till 6:00pm. The Clinic has two outreach locations located in Clyde and Jamestown. The Clyde clinic which was recently remodeled is now open four mornings a week, Monday thru Thursday and offers three private clinic rooms. The Jamestown location is open the 1st and 3rd Thursdays of the month in the mornings serviced by a Physician Assistant. The hospital has a total of 7 providers of which 3 are physicians and 4 are mid-level providers. The hospital operates an emergency department 24 hours per day, 7 days per week. The hospital's Board of Trustees is made up of members from all parts of the county, including local business leaders and retired individuals from Concordia and the surrounding communities.The services offered at CCHC include the following: IP Acute services IP ICU services IP swing bed services - patients requiring Therapy services or IV antibiotic services ED Services FCC Family Care Clinic Specialty Clinic Services Ancillary services including the following: Physical Therapy, Occupational Therapy and Speech Pathology services, Radiology Services including Ultrasound, Nuclear Medicine, CT Scan and Fixed MRI Services Laboratory Respiratory Therapy Cardiac Rehab Services Sleep Lab Services Operating Room OP Procedures Anti Coag Clinic Outpatient Services, including IV Therapy and Blood Transfusions |
| Part VI, Line 6: | CCHC is affiliated with Salina Regional Medical Center (SRMC). SRMC helps support our community by sending up Specialists to our Clinic monthly. Also, they provide subject matter experts that CCHC can call upon with questions in specific areas. They also help with Purchasing and Service contracts on equipment. SRMC also provides Accounting, Payroll, and HR services for CCHC. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Daniel Garlow | ||||||||||||||
| Physician | $213,195 | $0 | $70,817 | $0 | $0 | $0 | $14,285 | $0 | $19,754 | $0 | $318,051 | $0 | $0 | $0 |
| Dorothy Breault | ||||||||||||||
| Physician | $201,267 | $0 | $67,220 | $0 | $0 | $0 | $11,874 | $0 | $29,615 | $0 | $309,976 | $0 | $0 | $0 |
| Shawna Huggans | ||||||||||||||
| Advanced Practice Provider | $183,007 | $0 | $2,000 | $0 | $0 | $0 | $9,554 | $0 | $23,255 | $0 | $217,816 | $0 | $0 | $0 |
| Tiffany Naccarato | ||||||||||||||
| Advanced Practice Provider | $177,692 | $0 | $2,000 | $0 | $0 | $0 | $8,985 | $0 | $143 | $0 | $188,820 | $0 | $0 | $0 |
| Brandon Fraley | ||||||||||||||
| Advanced Practice Provider | $109,560 | $0 | $48,588 | $0 | $0 | $0 | $7,966 | $0 | $2,421 | $0 | $168,535 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part III | FormAndLineReferenceDesc |
| Explanation | Daniel Garlow, Dorothy Breault, Shawna Huggans, Tiffany Naccarato, and Brandon Fraley were paid by an unrelated organization, Salina Regional Health Center, for medical services performed. See Schedule J, Part II and Form 990 Part VII for amounts paid for these services. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part V, Line 1a, Number reported in Box 3 of Form 1096: | Cloud County Health Center, Inc. has independent contractors, however, Salina Regional Health Center, the management company, pays all the independent contractors directly. The actual expense of each independent contractor is directly charged to the assigned entity. |
| Form 990, Part V, Line 2a, Number of employees on W-3: | Under a management agreement, Salina Regional Health Center (SRHC) is responsible for the daily management and operation of the hospital, including employment of all staff. All payroll and benefits are paid by SRHC and payroll reporting is done by SRHC. Allocable compensation by individual is charged to Cloud County Health Center, Inc. and is shown on line 7 of Part IX. |
| Form 990, Part VI, Section A, line 3 | The Hospital entered into a management and operating agreement with Salina Regional Health Center (SRHC) effective May 1, 2016. Under the agreement, SRHC is responsible for the daily management and operation of the Hospital, including the employment of all staff needed to manage and operate Cloud County Health Center. For calendar year-end 12/31/2022, SRHC paid the following in compensation and benefits for individuals listed in Part VII: Ronald Harrington $166,200 David Garnas $300,428 Justin Poore $360,243 |
| Form 990, Part VI, Section A, line 6 | The Health Center's Board of Trustees is the sole member of the Health Center. |
| Form 990, Part VI, Section A, line 8b | The organization does not have committees with broad authority to act on behalf of the governing board. |
| Form 990, Part VI, Section B, line 11b | Form 990 is reviewed by the President & CFO. A copy of the return is provided to board members prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | The Health Center requires the trustees and key employees to sign an annual conflict of interest form. On the form they designate if they have any conflicts. Potential conflicts of interest are presented to the Board of Directors. The Board determines whether a conflict exists. If a conflict exists, the effected person will be required to abstain from voting on the matter. |
| Form 990, Part VI, Section B, line 15a | The Organization's process for determining the President's compensation begins with an initiative led by the Executive Compensation Committee (ECC) of Salina Regional Health Center (SRHC). The ECC compares compensation and salary data provided by Integrated Health Strategies (IHS) for overall reasonableness of base compensation and total compensation for all SRHC executive staff. The ECC reviews the data and makes a recommendation to the SRHC board of trustees in a closed executive meeting. This process occurs every October. Cloud County Health Center's President's salary is then set by the President/CEO of SRHC. The Cloud County Health Center CFO's salary is set by Salina Regional Hospital Vice President of Finance using an annual salary survey and is increased using the same percentage as all other employees. |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. |
| Form 990, Part XI, line 9: | Net Income From Auxiliary 2,567. Change in Beneficial Interest in Net Assets of the Foundation -679,426. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cloud County Foundation for Health Care Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 W College Drive | AddressLine1Txt |
| City | Concordia | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480966856 | EIN |
| Primary Activities | support community health and welfare | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 7 | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |